The darkness echoing: exploring Ireland's places of famine, death and rebellion. By Gillian O'Brien. Pp 373. Dublin: Doubleday Ireland. 2020. €21 paperback.

action on health reform could be viewed as radical, progressive and independent. Ireland in consequence was ahead of Britain and much of Europe in the enactment of childhood immunisation schemes. Despite this stance, it took years for a successful immunisation scheme in Ireland to be implemented. Dwyer chronicles the initiatives undertaken and reveals the many factors which helped or held back the development of immunisation in Ireland. These included obstruction by some from the wider medical community. He explores the different experiences of the major cities of Cork and Dublin and the different levels of success in implementing an immunisation programme. Explaining howmuch relied on the actions and motivation of the supervising medical officer as to whether there was successful uptake of the programme. Other problems had significant impacts such as the ill-fated Ring College incident, during which twenty-four children reportedly contracted tuberculosis and one twelve-year-old girl died following routine anti-diphtheria immunisation. Dwyer provides new evidencewhich suggests that liability lay with the local attending doctor and his advisors rather than with BurroughsWellcomewhere previous historiography has assigned the blame. Dwyer spends some time discussing the Burroughs Wellcome vaccine trials in Ireland held during the mid twentieth century. He reveals the more problematic aspects of the push to find and introduce an effective anti-diphtheria immunisation. He discloses how the rights of vulnerable children in institutional care were clearly side-lined. The scandal first came to light during the 1990s, but this study by Dwyer reveals the much wider prevalence of the practice by the company than previously thought. Furthermore, the available evidence suggests parents and guardians of children involved in trials were kept in the dark about the potentially lethal nature of the vaccines administered to the children. Dwyer points out that while the religious congregations behind these institutions have received considerable attention much less has been focused on the scientific andmedical communities behind the trials. In his opinion further investigation should focus on these communities and their actions. Dwyer also raises important questions around the ethical practices of those involved, who chose to carry out the trials on Irish children as British legislation prevented them from doing so on children in Britain. He queries why those involved deemed the children in Irish institutions as lesser beings and not offered the same protections as their British counterparts. His work fits more widely into the growing interest in recent years in uncovering institutional abuse of children in Ireland. Various reports have been published in recent years ― such as Ryan (2009), Ferns (2005) and Murphy (2009) ― which have revealed the wide extent of child abuse historically within Irish institutions. Dwyer’s book provides a well-written, thorough and thoughtful history of diphtheria immunisation in Ireland. His workmakes a significant contribution to the history of medicine in Ireland and more generally. Furthermore, the difficulties around the roll-out of immunisation schemes mirrors many difficulties experienced today, where a significant anti-vaccine movement exists. In consequence, this book provides useful and thought-provoking context to the current debate around vaccination and to the investigations into historic institutional abuse in Ireland.